Food As Medicine Global

The idea of food as medicine makes sense to many of us. More and more, nutrition is being centered in health professional training and patient care and in conversations around farming, fishing, ranching and other foodways. However, Indigenous people across many communities who would like to eat well just can’t access healthy food – or even enough food. Many of those producing and providing our food navigate a multitude of inequities. We are partnering in creating an equitable and inclusive food as medicine movement for Indigenous communities in Los Angeles and across the globe.

Affordability, limited healthy food options and poor geographical access are active barriers to health promotion among the community, as well as low show rates for nutrition appointments, health screenings and appointments. One’s ability to practice healthy eating and lifestyle habits is limited in such settings even if there is adequate nutrition knowledge at baseline. The lack of nutrition education and outreach in surrounding low-income communities results in less emphasis on healthy eating habits, and a lack of knowledge that many chronic diseases are nutrition related and could be preventable. 

Prior community efforts over the years have attempted to address above issues, addressing a single factor of social determinants of health at a time (discounts at weekly farmers market, community health classes in various neighborhoods). However, social determinants of health cannot be addressed in isolation and should be addressed jointly in order to create more effective outcomes desired by the community served. Resources addressing food insecurity and community health that are directly embedded within the communities themselves will better empower members to prioritize health and wellness. 

With LAC+USC Medical Center and Keck Medicine of USC’s unique position of being the main hospital systems serving the greater LA community and its focus on identifying and addressing barriers to health within local communities with an emphasis on diversity, we propose the establishment of the first integrated nutrition and community care model in Southern California. Adapting a successful localized food pantry, hospital rooftop farm model at Boston Medical Center, the aims are to localize food production and increase its accessibility, as well as improve culturally-sensitive and appropriate health care delivery in a densely populated, urban area serving the lower income communities. 

The Edible Healing Garden will be developed and maintained by LAC+USC and Keck Medical Center/USC School of Medicine. The goals are to:

1. Increase food security in SPA 4 and 7 by establishing a local hospital garden within the communities that provides weekly free, seasonal grocery kit for local residents. The garden will produce local high quality, nutrient dense, seasonal produce that includes cultural ingredients appropriate for the community. Patients of LAC+USC and Keck who are identified as food insecure and/or with chronic diseases can be referred by their providers to the food pantry as a “food prescription”. Production levels will continue to be scaled and eventually be high enough to offer some fresh local produce on patients’ trays. If additional space is available, faculty and staff may also participate as secondary beneficiaries of the garden by applying for allotments/participating in CSA program in order to generate revenue and sustain the garden for the long term. 

1. Improve patient and community’s access to culturally-inclusive nutrition and mental wellness care by introducing an integrated nutrition and wellness care model. Biweekly culturally sensitive nutrition, gardening and wellness classes provided to patients and families each quarter. Above lessons will be led by providers of color (Registered Dietitians, farmers, other medical providers). Classes will include: growing and eating seasonally, mindful eating, chronic disease management (kidney health, cardiovascular disease, cancer, diabetes, etc), and other relevant topics based on community interest. The goal is to increase show rates for nutrition and primary care appointments as well as increase nutrition knowledge, fruits and vegetable consumption. Collaboration with surrounding non-profits (eg. Legacy LA) will be sought to increase awareness/support of the hospital garden within the community. There will also be opportunities for medical student rotations.

2. Improve the attitude, behaviors, and relationships with food to promote lifelong healthy eating habits and the highest potential of quality of life that is sustainable.  We are producing materials that engender cultural pride, traditional food & healing practices as well as inter-generational info-tainment.

We serve the Indigenous and often undocumented Indigenous communities of Southern California.  Our team represents several local and national tribes, while also embodying the experience of inter-generational, trauma, violence, and genocide.

Poverty, limited access to healthcare, struggles with mental illness and employment, stability often lead to poor nutrition, and deleterious health assets. Our vision is to shore up these communities by bringing them back to the land, mother earth, that nurtures all of us we are implementing an initiative to distribute garden kits, as well as garden, produce in tandem with traditional and modern gardening, technology, including earthenware irrigation, milkweed hubs to support the bee population and traditional growing methods like “Four Sisters,”the Cherokee method for symbiotic growth of beans, squash, etc. 

weather in a flower pot, a windowsill garden box, or a local community garden plot, the power and impact of nutrition is undeniable. Our Food As Medicine Global program can impact individual A1C and kidney health as much as community, maternal and child wellness.

We serve the Indigenous and often undocumented Indigenous communities of Southern California.  Our team represents several local nations (Chumash, Tongva and Gabriellino) and national tribes (Cherokee, Muscogee Creek), while also embodying the experience of inter-generational, trauma, violence, and genocide.

our good sisters have been working in Ernest on community gardens for the last several years, planting traditional flora, repairing vandalism & graffiti, watering by hand, rehabbing the soil with compost and manure.  

We are bringing sweet grass, sage, milkweed and healing, herbal plants to our local community gardens. We wish to augment the healing and nutritional value of our plantings in tandem with our hospital sponsors ambitious plans to revitalize and empower community, Tribal and Indigenous nutrition.

Katherine Chen is our Food as Medicine visionary.  She is a registered dietitian with a passion for helping individuals and communities improve their health and well-being through proper nutrition and healthy lifestyle choices. She holds a Master of Science degree in Nutrition, Healthspan, and Longevity from the University of Southern California, and an undergraduate degree in Food Science and Human Nutrition from Cal Poly Pomona.

Throughout her career, Katherine Chen has worked in various healthcare settings, including hospitals, medical centers, and public health departments, providing comprehensive nutritional assessments, developing customized nutrition plans, and educating patients and families on healthy eating habits. Her areas of expertise include pediatric nutrition, diabetes management, transplant nutrition, and nutrition across the lifespan.

Katherine Chen is currently serving as a Health Facilities Consultant at a public health department, where she provides professional consultation to health facility administrators, nursing and dietetic staff, and consultant dietitians in the interpretation of laws, regulations, and standards governing licensing, accreditation, and certification for public agencies. She also advocates for methods of achieving compliance and upgrading patient care, and liaises with state and federal agencies and professional organizations to stay up-to-date on the latest legislative and regulatory developments in the field of dietetic and food services.

In addition to her work in public health, Katherine is also a passionate advocate for community gardens and sustainable agriculture. She currently serves as the Program Director for the Edible Healing Garden, a hospital housed community garden to help improve food equity, provide nutrition and gardening education, and promote cultural diversity in the greater Los Angeles area to the medically underserved. She is a globally conscious professional with a strong commitment to providing the highest quality of care to her patients and communities.

We are applying to solve to gain technical assistance on best practices to seed, nurture and replicate our Food As Medicine Global program in medical care, facilities, across Turtle Island and the globe.

Our team lead Christina Gonzales is a living, breathing part of the fabric of indigenous life in Southern California. A PhD candidate in non-traditional medicine, Christina is a committed advocate of community gardens, working with the LA Garden Council, USC Keck and individual tribes, including her own Chumash, Tongva and Gabriellino nations.

Our Unique Project Design includes:

Project Methods, Stages, Timeline 

• Stage One

  Nutrition classes, Intra-departmental and Community Collaborations

  • Three (3) monthly virtual classes per quarter 

    • Patients can participate for the quarter, or full year 

  • Topics: 

    • Recipes for seasonal produce

    • Mindful eating (recurring for each quarter)

    • Renal/diabetes diet (recurring for each quarter)

    • Cancer (recurring for each quarter)

    • Healthy meal prep (recurring for each quarter)

    • Other topics per participants through survey

  • In person, or virtual due to COVID 

  • Support groups

  • Cooking, gardening, nutrition classes, support groups 

    • Find out tools and resources needed: Seeds, pots, nutrition handouts 

    • MNT - reimbursements 

  • Recruiting participants: IP/OP referrals, hospital email lists, the wellness center, collaboration with surrounding local non-profits (Legacy LA, First Nations Storytellers et al)

    Stage Two:

  • Survey process: Sliding scale payment for farm produce
  • Determine # of people interested, start a waiting list, conduct intake interviews
  • Recruiting participants: local flyers, IP/OP referrals with physician champions, hospital email lists, collaboration with surrounding local non-profits (Legacy LA, First Nations Storytellers et al)
  • Potential site: Lincoln park space (sq footage, food production amount, security, oint use plan), Hollywood City lot
  • Physician champions: Keck - Dr Bocian (IM), County - Dr Heger (Peds)
  • Seeds for Change
  • Champions for Change
  • WM Keck Foundation
  • USC Good Neighbors
  • Keck’s Community Benefit and Outreach
  • Goal: Initial establishment cost fully funded by philanthropy/donations
  • Figuring out the scope of outreach area
  • Garden setup, food pantry

Stage Three

• Fees for allotments 
• CSA boxes
• Stage 3: Supplying produce for hospital trays, allotments for staff, special events

Food, Health Access & Sustainability —

Our Garden activities include a food bank, a “food pharmacy” that offers nutrition counseling and cooking classes, and a gardening-education program. We are building toward communities that do not solely rely on emergency food supplies because they can supplement their tables with home-grown healthy foods.

We are crowdsourcing traditional tales of family, cuisine and culture including an Indigenous cookbook for kids & families — featuring adventure stories behind recipes gathered from Native Americans from across Turtle Island.

Evaluation Methods, expected results 

Method:  Patients and participants will be selected based on eligibility criteria such as presence of diagnosis of a chronic health condition, identified food insecurity status, and personal interest.

     The referrals will be made by a clinician (primary physician, specialty physician, nurse practitioner, physician assistant, social worker) and/or a dietitian. 

      Once the patient/participant is approved for the referral, they will be enrolled into the program and be provided with a produce prescription based on their current health condition (e.g. renal, diabetes, atherosclerosis, etc.) to receive allotments of fresh plant foods. Additionally, they will be offered complimentary garden classes to attend in person or via Zoom on a monthly basis. These garden classes will educate participants on how food is grown, and the connections between science, nature, and health. Each class will also address human nutrition, environmental impact of food choices, cultural diversity, food anthropology, and gastronomy.

Evaluation

      The program will be evaluated based on objective and subjective measures. The objective metrics will be markers of health (such as metabolic panels, blood sugars, lipid panels) of patients referred to the Garden’s food pantry resource and nutrition knowledge based and pre and post tests. This data will reflect the effect of increasing healthy food accessibility in the biomarkers of patients as well as nutrition literacy. 

       The subjective measures will be extracted from pre and post surveys, focus groups, and patients’ self reports. To assess for food behaviours, food frequency questionnaires will be filled out by participants at the beginning of their participation in the program and subsequently for every 3 months thereafter. To assess for mental wellness, focus groups and interviews, as well as pre and post surveys, will be used to evaluate participants’ perceptions of the degree of benefit they are experiencing. 

• Enroll x% of food insecure households/patients into food pantry program (subsequent community needs assessment, pre post surveys, focus groups)

• Increased levels of produce consumption, nutrition knowledge within patients and communities (food logs, focus groups, pre post surveys)

• Improvement in mental wellness, quality of life (focus groups/interviews: pre post surveys) 

7.  Evaluation methods

• Subsequent community needs assessment for % food insecurity 

• Mental wellness, nutrition knowledge: pre post surveys, focus groups 

• Sustainability of project: volunteer log hours (staff/students/community), # participants in classes (in person, virtual), # lbs of food given out, # of collaborations with local non profits and businesses 

How research results will affect other research areas: integrated model’s effectiveness within community, can be implemented in other communities with high food insecurity as well.

By Identifying, Enrolling & Quantifying Stakeholders

We are partnering with existing Work Source & Family Source Centers in our target areas

We plan to empower our communities with information, gardening kits and info-tainment that speaks to health, mental health and improving nutrition.

Project Methods, Stages, Funding, Timeline 

• Stage 1: Nutrition classes, Intra-departmental and Community Collaborations

  • 3 monthly virtual classes per quarter 

    • Patients can participate for the quarter, or full year 

  • Topics: 

    • Recipes for seasonal produce

    • Mindful eating (recurring for each quarter)

    • Renal/diabetes diet (recurring for each quarter)

    • Cancer (recurring for each quarter)

    • Healthy meal prep (recurring for each quarter)

    • Other topics per participants through survey

  • In person, or virtual due to COVID 

  • Support groups

  • Cooking, gardening, nutrition classes, support groups, etc. 

    • Find out tools and resources needed: Seeds, pots, nutrition handouts, etc

    • MNT - reimbursements 

  • Recruiting participants: IP/OP referrals, hospital email lists, the wellness center, collaboration with surrounding local non-profits (Legacy LA, First Nations Storytellers et al)

The need for Food, Health Access & Sustainability is ongoing. We acknowledge that even 1% of change per day is doable and enough for measurable improvement.

We ask, “What can we create when the only thing in front of us is our hands?”  Like our ancestors in struggle, we embrace our creativity and proceed with Mother Earth to support us.

Weare integrating traditional medicine and the art of the office visit with more biologically sound dietary practices. Using the hospital as a hub to evaluate patients and gift them with food/garden kits, we feel this could be a powerful intervention. 

Added to this, we plan to use Web3 and Blockchain technology to encourage tribes and families across the Turtle Island to create NFT’s to gain entry to a private, COPPA compliant online info-tainment portal.  There we will showcase cultural, preservation and celebration in the form of tribal histories, stories and performances that celebrate the identities and traditions as well as foods of Indigenous communities.

We are very diverse as we have two Native American leaders, one Asian American, four women and part-time labor of several retired Veterans and  current students.

We want to fully build our model of nutrition improvement.  We have raised $12,000 so far and are looking to institutionalize our model and efforts at hospitals across Turtle Idland.

Grants and then fees for services, technical assistance and manufactured equipment like ollas and grey water irrigation and sanitation facilities.

We have raised $12,000 so far and revive on-kind support from the University of Southern California.